Infantile subdural haematoma in Auckland, New Zealand: 1988-1998

Abstract

Aim: To review the Auckland experience of traumatic subdural haematoma (SDH) in infants under 2 years of age, with particular regard to features which might help to differentiate accidental from non-accidental injury (NAI).

Methods: Retrospective review of the medical records of children under 2 years of age, coded for subdural haematoma (SDH) and retinal haemorrhage (RH) over a 10-year period.

Results: Sixty-four cases of SDH were identified. Forty-one of these were due to non-accidental trauma, and 23 cases were accidental. Differences between these two groups related to the age of presentation, ethnicity, the type of explanation for the injury, and differences in aspects of the clinical presentation (apnoea, seizures, fractures, retinal haemorrhage). Mortality in the non-accidental group was far higher.

Conclusions: Subdural haemorrhage is a significant cause of death and disability in infants presenting to hospital in Auckland. In the majority of cases, it is caused by child abuse, and there are certain features that are helpful in establishing this diagnosis. The long-term outcome in this group is unknown, but there is reason to believe that, in many cases, it is poor. There is considerable scope for further research.